To investigate the effect of a virtual feedback environment on compliance to prescribed session exercise load and to understand the user experience related to exercise participation.


Adult clients referred to an exercise physiology clinic wore a heart rate monitor while performing prescribed exercise twice per week over 2 intervention blocks of 2 weeks each. Participants undertook aerobic exercise both with and without a virtual feedback environment in random order. Compliance to prescribed exercise was assessed as heart rate relative to prescribed levels both within and across sessions. Participants reported average pain and rating of perceived exertion for the session and completed the PACES-8 enjoyment of exercise questionnaire at session completion. Treatment effects were assessed longitudinally using mixed-effects linear regression. At study completion, 2 focus groups (n = 12) were conducted and reported using thematic analysis.


Participants (n = 14) demonstrated higher mean compliance to prescribed exercise under the treatment (101 ± 10%) compared to control (50 ± 10%) condition (MD = 51%; 95% CI: 21–80; P = 0.001). Similar scores were observed under both the treatment and control conditions for rating of perceived exertion (12.3 vs. 12.2: P = 0.86), pain (2.37 vs. 0.85: P = 0.29), and enjoyment of exercise (41.2 vs. 38.6: P = 0.49). Focus groups identified themes related to biofeedback, interactivity and engagement, goal setting, and the visual environment.


Immersive feedback technologies can be effective to assist individuals with chronic clinical conditions to perform aerobic exercise within prescribed intensity ranges. Wide acceptability requires linking the exercise modality to the immersive environment and developing clear and meaningful goals.

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